Olecranon Bursitis Clinical Presentation

  • Author: Patrick M Foye, MD; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Aug 31, 2010
 

History

Patients with olecranon bursitis usually notice focal swelling at the posterior elbow.

Pain at the affected site is usually reported; however, the swelling is sometimes painless.

Pain is often exacerbated by pressure (eg, leaning on the elbow, rubbing against a table when writing with the ipsilateral hand).

Chronic recurrent swelling is usually not tender.

Frequent bumping of the swollen elbow occurs because it protrudes further than it normally would.

A history of isolated trauma (eg, contusion) or repetitive microtrauma may be present.

The onset of bursal inflammation may be sudden if it is secondary to infection or acute trauma.

The onset of bursal inflammation may be gradual if it is secondary to chronic irritation.

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Physical

The most classic finding of bursal inflammation is posterior elbow swelling, which is clearly demarcated by its appearance as a goose egg over the olecranon process (see the image below).

Olecranon bursitis is shown in a patient with the Olecranon bursitis is shown in a patient with the elbow extended. Image © 2007 by Patrick Foye, MD, UMDNJ New Jersey Medical School.

Tenderness to palpation is noted at the affected site.

The affected area may be warm and red, particularly in cases in which infection is present.

Skin inspection may reveal abrasion or contusion if there was recent trauma.

The patient's vital signs may reveal fever, but fever generally occurs only with advanced infection.

The affected elbow's range of motion (ROM) is usually normal, but occasionally the end-range of elbow flexion may be slightly limited due to pain.

Patients with systemic inflammatory processes (eg, rheumatoid arthritis) or crystal-deposition disease (eg, gout, pseudogout) may reveal evidence of focal inflammation at other sites. See the image below.

Gout. Radiograph of erosions with overhanging edgeGout. Radiograph of erosions with overhanging edges.

Rheumatoid nodules can be present on inspection of the elbow in rheumatoid arthritis. See the image below.

Arthritis, Rheumatoid. Rheumatoid nodules at the eArthritis, Rheumatoid. Rheumatoid nodules at the elbow. Photograph by David Effron MD, FACEP

Elbow pain during active or passive ROM may increase the clinical suspicion of an olecranon process fracture if a history of trauma exists. See the image below.

Olecranon fracture. Olecranon fracture.
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Causes

Bursal inflammation may be caused by a variety of mechanisms. Due to the superficial location of the olecranon bursa, it is susceptible to inflammation caused by acute or repetitive trauma, and less commonly, infection.

Acute trauma (eg, falling onto a hard floor or an artificial-turf playing field and then landing on the olecranon process)

Minor cumulative trauma (eg, repetitively rubbing the olecranon region against a desktop during writing)

Infection caused by abrasion or laceration at the affected site or by seeding from hematogenous spread via bacteremia

Inflammation as part of systemic inflammatory process (eg, rheumatoid arthritis) or crystal-deposition disease (eg, gout, pseudogout)

Side effect of sunitinib used to treat patients with renal cell carcinoma[6]

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Contributor Information and Disclosures
Author

Patrick M Foye, MD  Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society

Disclosure: Nothing to disclose.

Coauthor(s)

Todd P Stitik, MD  Professor, Department of Physical Medicine and Rehabilitation; Director, Outpatient Occupational/Musculoskeletal Medicine, UMDNJ-New Jersey School of Medicine

Todd P Stitik, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, Phi Beta Kappa, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Scott F Nadler, DO  Assistant Director of Occupational/Musculoskeletal Medicine, Assistant Professor of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, Director of Sports Medicine, University Hospital

Scott F Nadler, DO is a member of the following medical societies: American College of Occupational and Environmental Medicine, American College of Sports Medicine, American Medical Association, Association of Academic Physiatrists, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

Andrew L Sherman, MD, MS  Associate Professor of Clinical Rehabilitation Medicine, Vice Chairman, Chief of Spine and Musculoskeletal Services, Program Director, SCI Fellowship and PMR Residency Programs, Department of Rehabilitation Medicine, Leonard A Miller School of Medicine, University of Miami

Andrew L Sherman, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists

Disclosure: pfizer Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Henry T Goitz, MD  Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD  Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding

References

  1. McGee DJ. Elbow joints. Orthopedic Physical Assessment. 2nd ed. Philadelphia, Pa: WB Saunders Co; 1992:143-167.

  2. Strakowski JA, Wiand JW, Johnson EW. Upper limb musculoskeletal pain syndromes. In: Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders Co; 1996:756-82.

  3. Snider RK. Olecranon bursitis. Essentials of Musculoskeletal Care. 2nd ed. Rosemont, Ill: American Academy Orthopedic Surgeons; 1997:156-9.

  4. Morgan WJ. Elbow and forearm. In: Steinberg GG, Akins C, Baran D, eds. Orthopaedics in Primary Care. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1998:70-98.

  5. Brinker MR, Miller MD. The adult elbow. Fundamentals of Orthopaedics. Philadelphia, Pa: WB Saunders Co; 1999:153-64.

  6. Gregory T, Mir O, Medioni J, Augereau B, Oudard S. Olecranon bursitis in patients treated with sunitinib for renal cell carcinoma. Med Oncol. Jun 2010;27(2):446-8. [Medline].

  7. Schumacher HR. Arthrocentesis, synovial fluid analysis, and synovial biopsy. In: Schumacher HR, Klippel JH, Koopman WJ, eds. Primer on the Rheumatic Diseases. 10th ed. Richmond, Va: Arthritis Foundation; 1993:67-72.

  8. Weinstein PS, Canoso JJ, Wohlgethan JR. Long-term follow-up of corticosteroid injection for traumatic olecranon bursitis. Ann Rheum Dis. Feb 1984;43(1):44-6. [Medline]. [Full Text].

  9. Blankstein A, Ganel A, Givon U, Mirovski Y, Chechick A. Ultrasonographic findings in patients with olecranon bursitis. Ultraschall Med. Dec 2006;27(6):568-571.

  10. Floemer F, Morrison WB, Bongartz G, Ledermann HP. MRI characteristics of olecranon bursitis. AJR Am J Roentgenol. Jul 2004;183(1):29-34. [Medline]. [Full Text].

  11. Cardone DA, Tallia AF. Diagnostic and therapeutic injection of the elbow region. Am Fam Physician. Dec 1 2002;66(11):2097-100. [Medline]. [Full Text].

  12. Lennard TA. Fundamentals of procedural care. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:1-13.

  13. Ogilvie-Harris DJ, Gilbart M. Endoscopic bursal resection: the olecranon bursa and prepatellar bursa. Arthroscopy. Apr 2000;16(3):249-53. [Medline].

  14. Green SM, ed. Nonsteroidal anti-inflammatories. Tarascon Pocket Pharmacopoeia. Loma Linda, Calif: Tarascon Publishing; 2000:11-12.

  15. Olsen NK, Press JM, Young JL. Bursal injections. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:36-43.

  16. Friedman ND, Sexton DJ. Bursitis due to Mycobacterium goodii, a recently described, rapidly growing mycobacterium. J Clin Microbiol. Jan 2001;39(1):404-5. [Medline].

  17. Barham GS, Hargreaves DG. Mycobacterium kansasii olecranon bursitis. J Med Microbiol. Dec 2006;55(pt 12):1745-6. [Medline].

  18. Blankstein A, Ganel A, Givon U, Mirovski Y, Chechick A. Ultrasonographic findings in patients with olecranon bursitis. Ultraschall Med. Dec 2006;27(6):568-71. [Medline].

  19. Damert HG, Altmann S, Schneider W. [Soft-tissue defects following olecranon bursitis: treatment options for closure] [German]. Chirurg. Aug 7 2008;epub ahead of print. [Medline].

  20. Degreef I, De Smet L. Complications following resection of the olecranon bursa. Acta Orthop Belg. Aug 2006;72(4):400-3. [Medline].

  21. Jin W, Lee JH, Yang DM, et al. Olecranon bursitis communicating with an olecranon cyst in rheumatoid arthritis. J Ultrasound Med. Jun 2007;26(6):857-61. [Medline].

 
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Olecranon bursitis is shown in a patient with the elbow flexed. Image © 2007 by Patrick Foye, MD, UMDNJ New Jersey Medical School.
Olecranon bursitis is shown in a patient with the elbow extended. Image © 2007 by Patrick Foye, MD, UMDNJ New Jersey Medical School.
Olecranon bursitis is shown close up in a patient, with the elbow extended. Image © 2007 by Patrick Foye, MD, UMDNJ New Jersey Medical School.
Needle aspiration of olecranon bursitis. Image ©2007, by Patrick M. Foye, MD, UMDNJ New Jersey Medical School.
Olecranon bursitis aspiration of a hemorrhagic effusion. Image ©2007, by Patrick M. Foye, MD, UMDNJ New Jersey Medical School.
After fluid is removed from the olecranon bursa, an elastic, tubular, compressive sleeve can be used to minimize reaccumulation of the fluid. Image ©2007, by Patrick Foye, MD, UMDNJ New Jersey Medical School.
Gout. Radiograph of erosions with overhanging edges.
Arthritis, Rheumatoid. Rheumatoid nodules at the elbow. Photograph by David Effron MD, FACEP
Olecranon fracture.
Gout. Polarizing microscopy needles of urate.
 
 
 
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